The fatigued athlete. Dr Mérchen Naudé. Sport Doctor & Integrative Practitioner Forefitness & Health Sports Practice

Transcription

1 The fatigued athlete Dr Mérchen Naudé Sport Doctor & Integrative Practitioner Forefitness & Health Sports Practice

2 O Physiological fatigue : fatigue due to high intensity or high volume training O Fatigue due to a pathological condition O Fatigue is a symptom of most medical conditions/diseases O Further differentiate between CFS and overtraining syndrome O Review article: Chronic fatigue syndrome, Ray J Shephard. Sports Med March 2001, vol 31 issue 3:

3 Physiological fatigue O Fatigue due to a period of high volume or high intensity training O Resolve after period of rest O Management: Evaluate training programme and periodization Nutrition Sleep

4 Fatigue due to medical conditions O Iron deficiency O Anaemia O Underlying infections O Dysfunction of hypothalamic pituitary axis O Hormonal imbalances O Mood disorders O Underlying chronic disease or conditions

5 Iron deficiency Ferritin 60-80ng/ml or even higher in men O Increased loss due to training, bladder slap, feet slap, menstruation O Poor absorption due to decreased gut function O Poor intake of iron rich foods O Management: Nutrition IVI/IMI/oral iron supplementation Vit C, Probioticum, Colostrum, Candida Rx

6 Underlying infections Viral infections: UTRI, EBV, Coxsacke, SMV Bacterial infections: UTI, URTI Parasitic infestations: Intestinal parasites, malaria, Bilharzia Viral titres must be tested to determine reactivation of viral infection such as EBV, SMV Treat the underlying infection Increase the overall immune response of the athlete

7 Adrenal fatigue O Dysfunctional hypothalamic-pituitary adrenal axis/ Burnout O Symptoms: fluctuating fatigue, impaired memory, poor sleep, depression, sugar cravings, hypotension, impaired immunity, O Imbalance between excitatory and inhibitory neurotransmitters O Management: treat cause (stress, lifestyle, hypothyroidism, nutritional deficiencies, hormonal deficiencies) Adrenal Fatigue: The 21st Century Stress Syndrome James L Wilson, PhD

8 Hormonal imbalances O Thyroid imbalances: Hypothyroidism: fatigued all the time O Menopause / Andropause: fatigue early evening O Treatment: Obtain hormonal balance Iron and Vit D NB for thyroid Treat neurotransmitters Adrenal function must be optimal Mozani F et al Neuromuscular symptoms and dysfunction in subclinical hypothyroid patients. Clin Endocrinol , 1999

9 Mood disorders O Fatigue is an important symptom of depression or anxiety disorder O Thorough history including family history of mood disorders NB O Psychological stress leads to HPAA dysfunction leading cause of fatigue O POMS questionnaire helpful Morgan et al Mood disturbances following increased training Med Sci Sport Exer 1988;20:

10 Underlying medical conditions or disease O Humoral immune deficiencies (IgG3 deficiency) O Uncontrolled/ undiagnosed asthma or allergic disease O Cardiovascular pathology (myocarditis, endocardial O O O O fibrosis, IHD) Hypoglycaemia (neuroendocrine dysregulation, detrimental effect on immune system) Unresolved viral infections or EBV reactivation (exercise induced immune dysregulation of cytotoxic T cells) Auto-immune disease Malignancy Clinical investigation of athletes with persistent fatigue. Br J Sports Med 2004;38:4245

11 Overtraining syndrome O Failing to recover from training with two weeks rest, leading to prolonged fatigue and underperformance, as well as frequent minor infections O No other medical cause O Exact pathophysiology unknown O Multi-factorial Fatigue and underperformance inathletes: the overtraining syndrome Br J Sports Med 1998;32:

12 Overreaching vs overtraining O Overload leads to reduced vigour, increased tension, fatigue, increase in resting HR, depletion of glycogen stores, decrease in testosterone vs increase in cortisol- if recovery occur within two weeks it is normal response to training O Abnormal if the underperformance continues- esp if athlete trains harder rather than rest

13 Overtraining O Symptoms: underperformance, fatigue becoming progressively worse, heavy muscles, depression, sleep disturbances, loss of appetite, loss of drive, anxiety, irritability, increased resting HR and sweating, recurring URTI Hormonal changes: Increase salivary cortisol, low testosterone:cortisol ratio, hypoglycaemia, increase noradrenaline and decreased nocturnal dopamine, decreased glutamine levels

14 Management of overtraining O Holistic approach based on rest and regeneration O Exercise at HR min/day and build up over 6-12 weeks to 60min per dayfocus on volume not intensity O Cross training (avoid own sport) O Nutritional strategies

15 Chronic Fatigue Syndrome (CFS) O Fatigue disproportionate to the intensity of effort, persistent for more than 6 months, no obvious medical cause O Overtraining and-or negative energy balance may have precipitating factor in athletes O Causes include: psychological stress, mood disorders, HPAA dysfunction, hormonal imbalance, nutritional deficiencies, immune suppression, chronic infections The worn-out athlete: A clinical approach to chronic fatigue in athletes W Derman et al, J Sports Sci,1997,15, Fry RW, Morton AR, Keast D. Overtraining syndrome and the chronic fatigue syndrome. N Z J Sports Med 1991; 19 (3):48 52

16 Other causes O Sleep Disorders O Nutritional disorders O Psychological stress O Side-effects of medication (b-blockers, statins, anti-histamines, anti-hypertensives, CNS meds) O Pregnancy O Travel across time zones

17 Treatment of the fatigue athlete O Treat the cause O Meyers Cocktail (BOM): develop by John Meyer MD Lonsdale Alternative Medicine Review, vol 4, Issue APHA Katz 2006 Vit C anti-viral at high dosage; Mg activates cellular pumps, regenerate ATP depletion O B-vitamins O Mg, O Energising adaptogenic herbs (Rhodiala rosea, ginseng, Ashwaganda, liquorice) O Mitochondrial regeneration (l-carnitine, ALA, omega 3, glutathione, PC, NAC, GH, amino acids, taurine)

18 Conclusion a conclusion is simply the place where you got TIRED of thinking O Multifactorial O Exclude obvious medical conditions and lifestyle factors O Can be managed successfully with the cooperation of the athlete O Prevention better than cure!